Which is worthy to be adopted, carotid endarterectomy or carotid stenting for treatment of symptomatic carotid artery stenosis?

Abstract

Background: Carotid endarterectomy (CEA) has shown a valuable role in preventing stroke in symptomatic patients. However, it is limited by the presence of high-risk medical conditions. Alternatively, carotid artery stenting (CAS) has evolved as a less invasive therapeutic method.Objective: This study aimed to compare between outcomes of artery stenting and carotid endarterectomy in asymptomatic carotid artery stenosis patients.Methods: This retrospective cohort included 37 adult patients with symptomatic carotid artery stenosis. Patients were scheduled for either CAS (N=20) or CEA (N=17). The records were reviewed, and the patients' demographics, comorbidities, and clinical data were recorded. Carotid artery assessment via carotid duplex ultrasonography was also recorded. The primary endpoint of the study was the incidence of myocardial infarction or stroke within 30-days, and the incidence of death, stroke, or myocardial infarction at 1-year. The secondary endpoints included cranial nerve injury, restenosis, vessel maturation, intracranial haemorrhage, and any complications at the surgical site within one month after the procedures.Results: Within 30 days of the procedures, the incidence of stroke or transient ischemic attack was 20.0% in the CAS group compared with 17.6% in the CEA group with no significant difference (p>0.999). Myocardial infarction did not ensue in either group. No patients in the CAS group developed cranial nerve injury compared to two patients (11.8%) in the CEA group, with no significant difference (p=0.204). The occurrence of local hematoma was lower in the CAS group (5.0%) than in the CEA group (29.4%), but it did not reach a significant level (p=0.075). A 1-year follow-up, equal death, and stroke rates in the CAS and CEA groups were 10.0% versus 11.8% (p>0.999).Conclusions: Data from our present study indicate comparable death, stroke, or myocardial infarction rates within one month and at 1-year follow-up among patients who underwent CAS or CEA. Furthermore, there were no significant differences between CEA and CAS procedures regarding incidence rates of cranial nerve injury, local neck hematoma, or restenosis within one month of the procedures.